Expansion of physician assistants considered

Fresh conversations in Queensland about expanding the role of physician assistants (PAs) have renewed concerns from GPs about scope of practice changes in the state, and across Australia.
 
Queensland Health’s new Director-General Dr David Rosengren told newsGP, when questioned about the proposal to introduce more PAs into general practice, that the department was ‘committed to retaining our dedicated workforce while also building and attracting new talent pipelines’.
 
‘To ensure our clinical workforce operates at maximum scope of practice, we are exploring opportunities to grow our traditional workforce while also innovating and adapting alternative models of service delivery,’ he said.
 
‘This approach reflects a global trend, as health systems worldwide evolve to meet increasing demands, and we cannot afford to be left behind.’
 
RACGP Expert Committee – Funding and Health System Reform Deputy Chair Dr Michael Bonning said it came as no surprise that the state would be looking at this kind of reform.
 
‘Queensland has always been the kind of hotbed of activity for physician assistants,’ he told newsGP.
 
‘But we’ve got to understand why Queensland Health is doing this, as this feels like a short-term solution to chronic workforce issues and the challenge there needs to be to show the value of primary care teams and what it really means to do primary care well in our current paradigm.
 
‘We have to talk constructively with the Director-General, because we don’t want models of care that seek to cut out or avoid engagement with GPs.’
 
The RACGP has previously called for a stop to expansions of PAs in Australia, after GPs in the United Kingdom voted via the British Medical Association GP Committee to end hiring PAs in general practice within the NHS.
 
The results were an ‘overwhelming majority’ in favour of the role of PAs being deemed ‘fundamentally unsafe’ and existing roles to be phased out, the passing vote stated.
 
There are currently six physician assistants employed in Queensland – in the Townsville, Sunshine Coast and Darling Downs Hospital and Health Services.
 
Dr Bonning said although this proposal was at an early stage, it raises concerns about a national expansion.
 
‘We have to take developments associated with changes to scope of practice and access to health care very seriously,’ he said.
 
‘Anything that seeks to change the way in which general practice works, especially when it’s driven by an external party, and we have to think of Queensland Health as both being an organisation that is connected to general practice but is fundamentally outside of general practice – so I think this could be a future challenge.’
 
Queensland Health has developed a clinical governance guideline for PAs outlining the requirements for employment, supervision, practice limitations and ongoing professional development.
 
In its position statement, the RACGP stated the introduction of PAs was ‘not appropriate’ in Australia and said it could ‘reduce support for the current primary care workforce if funding is diverted to support a new health professional role’.
 
Any potential redirecting of funding for PAs could ‘undermine good general practice’, Dr Bonning said.
 
‘We still consider general practice and general practice teams to be underfunded and not being utilised enough to really realise the potential of high value, high quality care,’ he said.
 
Director-General Rosengren acknowledged the need to ‘grow our doctors, nurses and allied health workforce to meet demand now and into the future’.
 
He said Queensland Health would be engaging with key stakeholders ‘to develop further workforce strategies and reforms’.
 
But Dr Bonning warned again that ‘when the focus comes from predominantly outside groups on what to do to fix general practice’ it weakens the agency of GPs to address the challenges they face.
 
‘When you undermine that, you remove incentives for people to become GPs, because they don’t feel like they potentially have control of their own future in practice,’ he said.
 
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